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Dive into the research topics where Heather Y. Wolford is active.

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Featured researches published by Heather Y. Wolford.


Annals of Vascular Surgery | 2008

Is There a Selection Bias in Applying Endovascular Aneurysm Repair for Rupture

Richard W. Lee; Jeffery M. Rhodes; Michael J. Singh; Mark G. Davies; Heather Y. Wolford; Carol Diachun; Russell Norton; Karl A. Illig

Accumulating data suggest that endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) leads to reduced mortality, but concern exists that this may reflect selection bias. We reviewed our overall rupture experience early after our protocol was instituted to explore this question. We instituted a defined protocol for RAAA with emphasis on EVAR in July 2002, which included device availability (consignment), preoperative training, 24-hr access to our surgical endosuite and ability to operate imaging in an emergency, and immediate availability of a transbrachial balloon cutdown cart for all cases. Charts of all RAAA patients who arrived in the operating room alive since institution of our protocol were reviewed. Computed tomographic (CT) scans were re-reviewed to assess potentially suitable anatomic candidates. From July 2002 to May 2006, a total of 52 RAAAs were treated at our institution: 15 pararenal RAAAs, all treated by open repair (PR-OPEN), and 37 infrarenal RAAAs, 20 treated by open repair (IR-OPEN) and 17 treated by EVAR (IR-EVAR, 32% of all ruptures). Mortality rates in the three groups were 47%, 75%, and 35% (p < 0.02 vs. IR-OPEN), respectively. Although mortality was significantly lower in the EVAR group, overall mortality was 53% (28/52). On re-review of the operative notes and CT scans, it is estimated that more than half of those cases repaired using open techniques could have been repaired using EVAR based on anatomic criteria alone. The most common reason for open repair was hemodynamic instability preoperatively; only a minority of cases were excluded from EVAR based on unfavorable anatomy after CT scan review in the emergency room. In conclusion, during our early experience EVAR for rupture was associated with significantly reduced mortality. However, our overall mortality was no different from historical values, and this fact along with the extremely high mortality seen in the IR-OPEN group suggest that we are simply selecting patients with the greatest chance of survival to undergo EVAR. It also appears that many patients who are anatomically suitable for EVAR are undergoing open operation because of hemodynamic instability. If EVAR for rupture truly decreases mortality in all patients, a much more aggressive attitude toward EVAR may be required to lower the overall mortality rate.


Journal of Endovascular Therapy | 2005

Stacked proximal aortic cuffs: an "off-the-shelf" solution for treating focal thoracic aortic pathology.

Heather Y. Wolford; Scott M. Surowiec; Jeffrey H. Hsu; Jeffrey M. Rhodes; Michael J. Singh; Cynthia K. Shortell; Karl A. Illig; Richard M. Green; David L. Waldman; Mark G. Davies

Purpose: To report our early experience with the endovascular placement of stacked Zenith main body extensions (cuffs) in the treatment of focal thoracic aortic pathology in high-risk patients. Methods: Between January 2003 and May 2004, 6 patients (3 men; mean age 59 years, range 37–82) with focal aortic pathology underwent endovascular repair using stacked 30 and 32-mm-diameter Zenith main body extensions. The setting was a university tertiary referral center for vascular disease. Indication for treatment included 2 descending thoracic aneurysms and individual cases of traumatic thoracic tear, diverticulum of Kommerell, thoracic pseudoaneurysm, and aortoesophageal fistula. Results: All procedures were performed successfully, with a mean of 3 cuffs used. The patient with an aortoesophageal fistula expired after successful cuff placement due to sequela of massive pretreatment hemorrhage; fistula coverage was confirmed at autopsy. There were no type l endoleaks. Morbidity included an occluded right subclavian artery from traumatic passage of the device through the artery. No left subclavian arteries were covered. No neurological deficits or paraplegia was observed. The cuffs were patent in all surviving patients at an average follow-up of 7 months (range 3–12). Computed tomography in all survivors confirmed adequate cuff placement, absence of endoleak, and lack of cuff migration. Based on this experience, the following technical recommendations are offered: (1) right subclavian cutdown when needed to reach a lesion beyond the range of the sheath, (2) Dacron chimney placement, (3) stiff guidewire usage, (4) wire placement from the right subclavian artery through the common femoral artery if necessary to ease a sharp bend in the arch, and (5) cuff overlap of 25% to 50%. Conclusions: In high-risk patients, focal aortic pathology can be successfully treated with off-the-shelf commercially available cuffs using a stacking technique with acceptable mortality, morbidity, and short-term durability.


Journal of Vascular Surgery | 2005

Outcome after autogenous brachial-basilic upper arm transpositions in the post-National Kidney Foundation Dialysis Outcomes Quality Initiative era

Heather Y. Wolford; Jeffrey H. Hsu; Jeffrey M. Rhodes; Cynthia K. Shortell; Mark G. Davies; Arvind Bakhru; Karl A. Illig


Annals of Vascular Surgery | 2007

Management of effort thrombosis of the subclavian vein: today's treatment.

Adam J. Doyle; Heather Y. Wolford; Mark G. Davies; James T. Adams; Michael J. Singh; Wael E.A. Saad; David L. Waldman; James A. DeWeese; Karl A. Illig


Annals of Vascular Surgery | 2008

Subclavian Artery Revascularization: An Outcome Analysis Based on Mode of Therapy and Presenting Symptoms

Eugene Palchik; Andrew M. Bakken; Heather Y. Wolford; Wael E. Saad; Mark G. Davies


Archive | 2008

Hay un sesgo de seleccin en la reparacin endovascular de aneurismas rotos

Richard W. Lee; Jeffery M. Rhodes; Michael J. Singh; Mark G. Davies; Heather Y. Wolford; Carol Diachun; Russell Norton; Karl A. Illig


Annual Symposium of Society for Clinical Vascular Surgery | 2008

Evolving Strategies in Treatment of Isolated Symptomatic Innominate Artery Disease

Eugene Palchik; Andrew M. Bakken; Heather Y. Wolford; David L. Waldman; Mark G. Davies


Annales De Chirurgie Vasculaire | 2008

Y a-t-il un biais de sélection dans l'application du traitement endovasculaire pour rupture d'anévrysme ?

Richard W. Lee; Jeffery M. Rhodes; Michael J. Singh; Mark G. Davies; Heather Y. Wolford; Carol Diachun; Russell Norton; Karl A. Illig


Annales De Chirurgie Vasculaire | 2008

Revascularisation de l'artère sous-clavière : analyse des résultats en fonction du mode de traitement et de la symptomatologie

Eugene Palchik; Andrew M. Bakken; Heather Y. Wolford; Wael E. Saad; Mark G. Davies


Anales de Cirugía Vascular | 2008

Hay un sesgo de selección en la reparación endovascular de aneurismas rotos

Richard W. Lee; Jeffery M. Rhodes; Michael J. Singh; Mark G. Davies; Heather Y. Wolford; Carol Diachun; Russell Norton; Karl A. Illig

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Karl A. Illig

University of South Florida

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Michael J. Singh

University of Rochester Medical Center

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David L. Waldman

University of Rochester Medical Center

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Carol Diachun

University of Rochester Medical Center

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James A. DeWeese

University of Rochester Medical Center

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James T. Adams

University of Rochester Medical Center

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